Negative Coping
- Feb 16, 2025
- 5 min read
Medicine is a never-ending journey and a highly demanding field, which can place many medical students at risk of stress and burnout [1]. When faced with stress, we often employ a range of coping mechanisms, which can be either adaptive or maladaptive.
Coping mechanisms are defined as the “conscious volitional effort to regulate one’s emotions, thoughts, and behaviours, in response to stress” [2]. These mechanisms are generally divided into problem-focused and emotion-focused coping. Problem-focused coping are the responses attempting to influence the stressful situation, such as gathering information, generating possible solutions and taking action. In contrast, emotion-focused coping includes expressing one’s emotions, seeking support from others, and avoiding the problem to alleviate the negative feelings arising from the stressful event [4].
While some coping mechanisms are beneficial, others are associated with negative outcomes and are therefore considered maladaptive. Maladaptive coping likely stems from adverse childhood experiences [3] and often provides only temporary relief from stress while leaving the underlying issues unaddressed, thereby creating a vicious cycle. These maladaptive strategies include self-distraction, denial, venting negative emotion, substance use, behavioral disengagement, and self-blame [4].
Research has shown that maladaptive coping mechanisms are significantly positively related to burnout, as well as depressive and anxiety symptoms [5, 6]. Specifically, emotional suppression, denial and avoidance, have been found to correlate strongly with internalizing symptoms of psychopathology, such as depressed mood and anxiety [5]. Additionally, a study conducted among medical students revealed that dysfunctional coping strategies such as alcohol and drug use, withdrawal, rumination and excessive gambling on mobile phones and PCs are positively related to burnout [6].
In contrast, adaptive coping mechanisms such as problem-solving, positive reinterpretation and emotional expression promote engagement. These strategies facilitate student adaptation to stress and help reduce anxiety and depression [7]. Therefore, it is crucial for us to be aware of the coping mechanisms we employ and to seek support in developing healthier strategies to manage stress, ultimately improving our mental well-being.
Medical school is indeed a tough, stressful journey. With many potential stressors ahead of us, adapting comparatively positive coping habits help foster greater life satisfaction with improved physical and mental health benefits [8]. We are probably all aware of the need to change for the better - the hard part is always putting our foot down for change. Personally, 小編 gets intimidated just thinking about the amount of self-discipline needed to instill drastic changes in my daily routine…
For those who relate with my frustration, fear not because there is evidence we can change our coping behaviours! Introducing the Integrated Theory of Health Behavior Change (ITHBC), it suggests that it is indeed possible to change negative coping behaviours into positive ones [9].
The ITHBC proposes three domains for health behaviour change. For easier understanding, we’ve included some suggested pointers that may act as approaches for your positive-coping journey:
1️⃣ Knowledge and Beliefs
One way to start making changes is by in-depth realization of our current state. What coping behaviours, be it positive or negative, have we observed recently? From detailing our specific actions, we may reflect on how these behaviours have affected us, and how they make us feel. Evaluating behaviours that we hope to remove, modify and maintain is helpful in motivating us for the next domain!
2️⃣ Increasing Self-regulation Skills and Abilities
Goals and plans help encourage us to make self-monitoring decisions! These are not simply limited to negative coping behaviours, but may also be used to introduce/ maintain positive habits as well. We can start by planning gradual checkpoints, rewards and an ultimate timeframe on achieving.
3️⃣Enhancing Social Facilitation
Support and influence is especially important in every step of our coping improvement journey! Social influence is not limited to just peers - support can come from different sources, depending on who you choose to accompany you on your journey. Therefore, aside from friends and family, they may also include healthcare workers, multi-media resources, or recognised publications! For example, 小編’s friends recently imposed a friendly HKD$10 penalty for doomscrolling in the library :)
Remember these are meant to be steps in our journey of self-growth, not a guilt-ridden walk of shame! We may be at a different pace with others, but we are all putting forth a respectable commitment that we all will be proud of someday. Even if we’ve only just started, realizing the need for change in itself is already crucial in transforming our coping behaviours [10]. This includes reading this caption, so take a moment to give yourself a well-deserved pat on the back for dedicating these few minutes to your personal growth!
小編’s finals are not that far away, and I’ve only recently recognised how much I wish to tackle my current coping mechanisms. :/ But it has allowed me to self-evaluate and motivate myself for change! Wherever you are in your journey, let’s make mutual promises to better ourselves and… pass together! ^^
References
[1] Ishak, W., Nikravesh, R., Lederer, S., Perry, R., Ogunyemi, D., & Bernstein, C. (2013). Burnout in medical students: a systematic review. The clinical teacher, 10(4), 242–245. https://doi.org/10.1111/tct.12014
[2] Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping With Stress During Childhood and Adolescence: Problems, Progress, and Potential in Theory and Research. Psychological Bulletin, 127(1), 87–127. https://doi.org/10.1037/0033-2909.127.1.87
[3] Wadsworth, M. E. (2015). Development of maladaptive coping: a functional adaptation to chronic, uncontrollable stress. Child Development Perspectives, 9(2), 96–100. https://doi.org/10.1111/cdep.12112
[4] Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267–283. https://doi.org/10.1037/0022-3514.56.2.267
[5] Compas, B. E., Jaser, S. S., Bettis, A. H., Watson, K. H., Gruhn, M. A., Dunbar, J. P., Williams, E., & Thigpen, J. C. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological bulletin, 143(9), 939–991. https://doi.org/10.1037/bul0000110
[6] Erschens, R., Loda, T., Herrmann-Werner, A., Keifenheim, K. E., Stuber, F., Nikendei, C., Zipfel, S., & Junne, F. (2018). Behaviour-based functional and dysfunctional strategies of medical students to cope with burnout. Medical Education Online, 23(1), 1535738. https://doi.org/10.1080/10872981.2018.1535738
[7] Fares, J., Al Tabosh, H., Saadeddin, Z., El Mouhayyar, C., & Aridi, H. (2016). Stress, Burnout and Coping Strategies in Preclinical Medical Students. North American journal of medical sciences, 8(2), 75–81. https://doi.org/10.4103/1947-2714.177299
[8] Zou, M., Liu, B., Ji, J., Ren, L., Wang, X., & Li, F. (2024, January 3). The relationship between negative coping styles, psychological resilience, and positive coping styles in military personnel: A cross-lagged analysis. Psychology research and behavior management. https://pmc.ncbi.nlm.nih.gov/articles/PMC10771775/#:~:text=According%20to%20the%20theory%20of,and%20physical%20health%20and%20enhance
[9] Ryan, P. (2009). Integrated theory of health behavior change: Background and intervention development. Clinical nurse specialist CNS. https://pmc.ncbi.nlm.nih.gov/articles/PMC2778019/
[10] Lippke S, Ziegelmann JP. Understanding and modeling health behavior: the multi-stage model of health behavior change. J Health Psychol. 2006;11(1):37–50. doi: 10.1177/1359105306058845
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